Concussion and stress: they share the most logical connection for all of us who suffer from lingering concussion symptoms. However, in my experience, not much has been written or said about it. It feels like another taboo surrounding living with concussion symptoms. Well, let’s blow that taboo wide open! 

Professor Tenovuo shares 3 major sources of stress after concussion that create even more and bigger problems. This is how post-concussion depression came up, too. You will learn how this is more normal than you might think. Mental health after traumatic brain injury is a big thing, and it cannot get enough attention!

If you haven’t yet listened to episode 1 and 2, please find them right here:

• Episode 1: post-concussion symptoms
• Episode 2: post-concussion protocols

Table of contents:

02:52 Concussion and stress
07:01 Melanie’s work situation after concussion
08:58 Concussion and depression
11:02 Treat post-concussion depression

Concussion Stories podcast introduction

[00:00 Melanie] If I say there is hope for complete recovery for people with a concussion, you say…?

[00:07 Professor McCrea] 100%!

[00:08 Professor Maas] And in fact, you didn’t only feel it: you were outside the regular medical system, because they were not interested in you.

[00:16 Professor Sitskoorn] Neuroplasticity actually opens you up to the world. It makes it possible to develop; it makes it possible to rehabilitate.

[00:25 Professor Wilson] Traumatic brain injury has been called a silent epidemic for that reason, because it consists of changes and disabilities that are not obvious to other people.

[00:35 Dr. Zasler] If, as a physician, you felt you had nothing to offer a patient, then I think ethically, you need to say] “I don’t think there’s anything I can offer you. Maybe you should see Dr. M.”

[00:48 Professor Diaz-Arrastia] Historically, we have called these things mild traumatic brain injuries, which implies that, well… It may be a brain injury, but it’s not going to have great consequences, right? And that’s frankly not true.

About the Concussion Stories podcast

[01:05 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your post-concussion recovery journey. My name is Melanie and I spent six and a half years learning, experimenting, and training in order to find a way to heal myself from post-concussion syndrome.

After making a full recovery by the end of 2018, I embarked on this mission to make the recovery journey easier for you. This is why I started this podcast, wrote detailed blog post and downloadable guides, offer coaching and also the course that I wish I had back when I was recovering — teaching you everything that I needed to know in order to make my recovery happen.

On Concussion Stories, we dig deep while discussing hopeful stories of recovery as well as the hard stuff in the messy middle. Let’s dive right in!

Professor Tenovuo

This already is episode number three out of four with Professor Tenovuo! Have a listen to the episode about renaming post-concussion syndrome as ‘post-concussion symptoms’ with him, too. Aside from being professor of neuro-traumatology at the University of Turku in Finland and being part of CENTER-TBI, the large European research group researching traumatic brain injury, he is a compassionate doctor who has seen over 6,000 patients and truly understands the implications of lingering concussions.

In this episode, he and I discuss common things that cause stress after concussion and how important it is to recognize and eliminate them as much as you can. We also cover post-concussion depression, which is more normal than most people think. Let’s listen to Professor Tenovuo.

Concussion and stress

You wrote to me about a topic you would like to speak about: the stress from the uncertainty coming with traumatic brain injuries, what can you share about this? What are things that you want people to know?

[03:10 Professor Tenovuo] Yeah, of course. There are many sources of stress for mild traumatic brain injury patients. 

Almost no help for concussion from doctors

We have already discussed the stress source for post-concussion patients who often don’t feel like getting any help from medical professionals. That, of course, is a major source of stress after concussion.

Return to work after concussion

Another major source of stress is if patients have been considered to have a minor injury, concussion or mild TBI, they are expected to go back to work, although they are not fit to do that yet. They try to cope, but stressed people usually can’t manage their job. However, they want to keep their job and earn their daily living. So they try to cope. 

It often happens that post-concussion patients realize that things are not going well, but they don’t really understand why they cannot manage their work as they did before. They try to cope and cope, and start developing sleep problems, post-concussion depression and exhaustion. Things become more complicated, because they don’t get any help. 

They try to cope, although they don’t have the energy to manage the issues they should do in their daily lives. This causes a lot of stress surrounding concussion.

Financial stress after concussion

The third source of ‘concussion stress’ is a very common problem: concussion insurance compensation is difficult. You should be compensated somehow if you are unable to work. Many mild traumatic brain injuries happen in accidents that are covered by different types of insurance, such as traffic accidents or work related accidents, and so on. 

In my experience, and this varies between countries, these types of accidents are insured by private insurance companies. They often want to see that there is nothing major wrong: you should be able to work. And then they don’t compensate you. The reality is then that you are not able to work, but you are not able to get sick leave either. You are unable to get compensation anywhere. That is, of course, a major cause of stress for anybody.

Post-concussion stress inhibits recovery

So, our system is creating many additional sources of stress for post-concussion patients. From there, things start to get even more complicated. And then you have even less energy left to recover from your traumatic brain injury.

[06:34 Melanie] Yes. If you sum it up the way you do, it just feels like the whole system… What I am now going to say is an exaggeration, so I wouldn’t normally state it as bluntly as I will now. It sounds like the system is working against you when your brain already is not working. It’s already having to cope, and then the situation is made only worse.

[07:00 Professor Tenovuo] Yeah.

Melanie’s work situation after concussion

[07:01 Melanie] I feel I’m lucky. I am privileged to be from the Netherlands. When I got my concussion, I was working in a big corporation. They were able to sustain me in a way, to help me. I was able to keep my job while having sick leave. Building up my hours was really hard because the medical doctor was employed by the company and expected me to build up much faster than I could. 

Unable to cope while returning to work

I was not able to vocalize what I needed back then, because I was really unaware of how I should deal with the situation, of course. The company doctor tried to get me back to work. I was trying to get back to work, too, because I wanted to be the person I was before. But I just couldn’t.

Luckily, my manager really helped me. However, I know that a lot of people are not in that privileged situation. When you don’t have your job anymore, you’ll get into financial trouble. Not to mention lawsuits that a lot of people with brain injuries are involved in. How do you manage with a brain that doesn’t work?

Problematic insurance of post-concussion patients

[08:15 Professor Tenovuo] Yeah. Maybe I have a negative attitude on these issues. As I said, things are different in different countries. However, somehow I think that some insurance companies make use of the problem that post-concussion patients are not able to handle their own issues.

[08:48 Melanie] Yeah, this is why we need to change things.

[08:54 Professor Tenovuo] Yeah, I agree.

Concussion and depression

[08:58 Melanie] You already mentioned post-concussion depression. Is this something you see a lot in practice?

[09:10 Professor Tenovuo] That is a difficult question. In principle, yes, of course. What you see quite often is that things really get complicated: patients with concussion are not able to work and are not compensated anywhere. Most of these people develop depression. Who wouldn’t in that kind of life situation? 

Who wouldn’t develop depression?

Your life has changed. You are not okay. You are unable to cope with everyday things in your life, you are unable to work and you don’t get compensated, so you will develop financial problems. You get poor sleep because you have so many worries in your daily life. I think I would say that it would be abnormal if one doesn’t develop any kind of depression in that kind of situation.

Post-concussion depression is more normal

[10:09 Melanie] Really, I am thankful for you saying that way. A lot of people with post-concussion syndrome feel like they shouldn’t speak out about their depression. However, I think that it is to be expected, if you suffer from prolonged concussion that one might develop depression. People shouldn’t be afraid of it, and they shouldn’t expect it, like: “Now it’s coming”. But it’s really like you say: post-concussion depression is more normal than people think.

[10:42 Professor Tenovuo] Yeah, of course. As people we react with depression if we face major difficulties in our lives. That is a way of reacting to difficult life conditions. 

Treat post-concussion depression

Of course, the question is: when and how should depression after concussion be treated? That is another question.

Many major studies have shown that more than half of the patients with TBI (traumatic brain injury) develop depression at some point. Although depression is prevalent also in the so-called ‘normal’ population, this percentage among TBI patients is way higher than in the normal population.

Is it a psychiatric disorder?

We have to consider: is the degree of depression such that you should do something about it? Does it prevent you from making progress? Is it so severe? Or is it just a normal reaction to the situation? Is it in a way an ‘adequate’ depression for the situation and an adequate reaction to the life situation? Or is it a psychiatric disorder that you should treat?

[12:15 Melanie] Yes, I fully understand that as a doctor you are looking at it from this perspective.

Fight any kind of depression head-on

What I always tell patients with post-concussion syndrome is the following. If you feel depressed, treat it. Start working on it right away. See if you can find a psychologist, see if you can read on the internet about how to cope with depression. I also wrote a guide about post-concussion depression. 

In any case, it’s important to fight it head on, because if depression lingers, it will just become worse and worse. You don’t want to go there. So always manage it right away, whatever the diagnosis may be.

[12:58 Professor Tenovuo] Yeah, it’s very easy to develop different kinds of vicious circles after mild traumatic brain injuries. You have problems and then start developing depression after concussion. You develop sleep problems, and things get only worse and worse. Then you have a mess everywhere. Even if you treat one of the problems, you still have the others left. And then you are not making any progress.

Share your thoughts with me?

[13:31 Melanie] Now, I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to lifeyana.com and leave your comment now.

And if you want to hear and read more Concussion Stories, actionable steps and inspiration, be sure to subscribe to the Lifeyana email list while you’re there, so that you never miss out on new materials we constantly make for you.

If you want to support this podcast, head on over to patreon.com/concussionstories. Thank you for listening to this concussion stories episode by Lifeyana. May you will be well and may you be happy.